After a spike in deaths, B.C. opens 18 overdose-prevention sites in less than two weeks.

B.C.’s overdose epidemic appears to have entered a new, more deadly phase. Yesterday (December 19), the coroners service revealed that 126 people died of illicit-drug overdoses during the course of November. About four people every day.

That puts the total for the first 11 months of the year at 755 deaths, a 70-percent increase over the same period of 2015.

While those numbers were only just released to the public this week, it’s likely that B.C. health minister Terry Lake saw them earlier. My guess is he had them during the first week of December.

On December 8, Lake announced he was issuing a ministerial order to see “overdose-prevention sites” immediately open in Vancouver and shortly after in Surrey and Victoria.

Since then, common questions I’ve received are: what is an overdose-prevention site? And how do overdose-prevention sites differ from a “supervised-injection site” like Vancouver’s Insite facility?

Here’s part of the answer I received from the Ministry of Health:

“People who use illicit drugs are not supervised at overdose-prevention sites,” it begins. “At supervised consumption services, people are supervised as they do illicit drugs. The purpose of an overdose prevention services is to monitor people who have used illicit drugs for signs of an overdose, and provide rapid intervention when an overdose occurs, preventing catastrophic brain injury and death.”

Emphasis appears to be on the words “supervised” and “monitor” and subtle differences between meanings of the two.

A ministry background document notes that supervised-injection sites (SIS)—or supervised-consumption sites, as the government now calls them—offer complementary services such as HIV-prevention programs and consultations for addictions counselling. It also stresses that overdose-prevention sites (OPS) are designed as a “temporary measure in response to a public health emergency”.

So a supervised-injection site is different from an overdose-prevention site in that the former includes complementary services while the latter can function with only minimum health services.

An overdose-prevention site might be nothing more than a designated location where users can bring drugs and inject them while at least one person remains close by to intervene should an overdose occur. That person does not have to be a health-care professional; it might be another past or present drug user who has only received a one-hour course in overdose response.

There are only two supervised-injection facilities in B.C.

The first is Insite, at 138 East Hastings Street. That’s a low-barrier facility where anybody can walk in, obtain supplies for injecting drugs, and use them there under the watchful supervision of trained nurses.

The second is an integrated supervised-injection facility inside the Dr. Peter Centre in Vancouver’s West End. That site requires a person to be a member of the Dr. Peter Centre before they can use the injection room there.

Authorities in Vancouver and Victoria have applied to Ottawa to open another four supervised-injection sites. Those applications are pending approval. Other jurisdictions are in the process of drafting applications.

The process those applications were filed under is another significant difference between supervised-injection sites and overdose-prevention sites.

Opening a supervised-injection site requires a municipality to seek an exemption from federal drug laws, but the B.C. government has said that the same lengthy process is not required to establish an overdose-prevention site. That makes the latter significantly easier to open.

While there are only two supervised-injection sites in B.C., since Lake’s December 8 announcement, the province's five regional health authorities have opened 18 overdose-prevention sites.

Vancouver hosts the largest number of these new programs. There are five, all of them in the Downtown Eastside.

Surrey and Maple Ridge have two each, and Langley has one.

Overdose-prevention sites have also opened in Kelowna, Kamloops, Victoria, and Prince George

These overdose-prevention sites offer different levels of services and operate in different ways, depending on the city hosting them and organization running them.

For example, Vancouver’s new overdose-prevention site at 528 Powell Street is staffed by registered nurses and supplies users with harm-reduction supplies that make using intravenous drugs less dangerous.

Meanwhile, a December 19 Fraser Health media release states that overdose-prevention sites in Langley, Abbotsford, and Maple Ridge will be staffed by “outreach personal” (as opposed to health-care professionals such as nurses). It notes that although staff are equipped to respond to an overdose, the sites are not designed to offer “supervision of illicit drug consumption” (Instead, it explains, staff "monitor and observe").

On December 12, the federal government unveiled sweeping reforms aimed at making it easier for cities to establish supervised-injection facilities for drug users. It will, however, likely be several months until those measures take effect.